Bite wing technique

Question 1

what is the bite-wing technique?

Answer 1

• a method used to examine the interproximal surfaces of teeth

Question 2

important terminology **

Answer 2

• interproximal
• interproximal examination
• bite-wing film
• alveolar bone
• crystal bone
• contact areas
• contacts, open
• contacts, overlapped

Question 3

principles of the bite-wing technique

Answer 3

• film is placed in the mouth parallel to the crowns of both the upper and lower teeth
• the film is stabilized when the patient bites on the bite-wing holder
• the central ray is directed through the contacts of the teeth, using a +10 degree vertical angulation

Question 4

what is the bite-wing film holder?

Answer 4

• Rinn XCP bite wing instrument

- a device used to position an intramural film in the mouth

Question 5

what is a bite-wing tab?

Answer 5

• a heavy paperboard tab or loop fitted around a periapical film and used to stabilize the film during exposure

Question 6

film sizes and what they’re used for in bite-wing technique

Answer 6

• size 0: for posterior teeth of children with primary dentition
• size 1: for the posterior teeth of children with mixed dentitions
• size 2: for posterior teeth of adults, placed horizontally or vertically
• size 3: for bitewings, not recommended for adult patients

Question 7

what is the angulation of position indicating device?

Answer 7

• the alignment of the central ray of the x-ray beam in the horizontal and vertical planes

Question 8

what is the correct horizontal angulation?

Answer 8

• the central ray is directed perpendicular to the curvature of the arch and through the contact areas of the teeth

Question 9

what is the result of incorrect horizontal angulation?

Answer 9

• results in overlapped incorrect horizontal angulation

Question 10

what is vertical angulation?

Answer 10

• the positioning of the PID in a vertical or up and down plane

Question 11

what is positive vertical angulation?

Answer 11

• the PID is positioned above the occlusal plane and the central ray is directed downward

Question 12

what is negative vertical angulation?

Answer 12

• the PID is positioned below the occlusal plane and the central ray is directed upward

Question 13

what is the correct angle for vertical angulation in the bite-wing technique?

Answer 13

+10 degrees

Question 14

what does incorrect vertical angulation in the bite wing technique result in?

Answer 14

results in distorted image

Question 15

rules for bite-wing technique

Answer 15

• film placement
• film positions
• vertical angulation
• horizontal angulation
• film exposure

Question 16

step-by-step procedures of bite-wing technique

Answer 16

• patient preparation
• equipment preparation
• exposure sequence for film placements
• film placement

Question 17

patient preparation in the bite-wing technique

Answer 17

• explain the radiographic procedure to the patient
• position the patient upright in the chair
• adjust the headrest
• place and secure the lead apron with thyroid collar
• remove all objects from the mouth

Question 18

equipment preparation:

Answer 18

• set the exposure factors

- open the sterilized film package containing the film holder if a film holder is used

Question 19

exposure sequence for film placements

Answer 19

• 2 bite-wing films are typically exposed on each side of the arch
• one bite-wing film may be sufficient when posterior teeth are missing

Question 20

exposure sequence for film placements in full mouth series

Answer 20

• expose all anterior periapical films first
• follow with posterior periapical films
• finish with bite-wing exposures

Question 21

exposure sequence for film placements in bite-wings only

Answer 21

• expose the premolar bite-wing film first
• expose the molar bite-wing film last
• film placement is the specific area where the film must be positioned before exposure (dictated by the teeth and surrounding structures)

Question 22

bite-wing film placement

Answer 22

• the white side of the film faces the teeth
• in the posterior bite-wing series, the films are placed horizontally
• THE IDENTIFICATION DOT HAS NO SIGNIFICANCE IN THE BITE-WING PLACEMENT
• centre the film over the area to be examined
• ask the patient to ‘slowly bite’ on the bite-wing tab or bite-block of the film holder

Question 23

what are vertical bite-wings used for?

Answer 23

• used to examine the level of alveolar bone
• placed with the long portion of the film in a vertical direction
• seven films are used to cover canine, midline, premolar and molar areas

Question 24

modifications in the bite-wing technique for edentulous spaces and bony growths

Answer 24

• edentulous spaces: a conn ton roll must be placed in the area of the missing tooth to support the bite-wing tab or film holder
• bony growths: the film must be placed between the tori and the tongue

Question 25

helpful hints: posterior premolar BW

Answer 25

• see all of mn canine on the film (at least 1/2)
• aim for middle/corner of the eye
• cross the arch with anterior border of film

Question 26

helpful hints: posterior molar bitewing

Answer 26

• position the bitewing with tongue and 6 or 7
• slowly move back to proper position
• open and close technique
• anterior border of film on 3/4 on mn 5
• watch curve of mn
• ensure film is parallel with teeth vs parallel to midline

Question 27

helpful hints: cone cutting

Answer 27

• stand directly behind PID

- use your finger to align cone